Making the Flu Vaccination service work in your pharmacy Supporting Community Pharmacy across Avon
Outcomes of the Evening • Why has the service been commissioned? • How to run the service • Self Accreditation – Declaration of Competence • PharmOutcomes • How to maximise uptake of the service – Staff Engagement – How to target the correct patients • Your commitment Supporting Community Pharmacy across Avon
Why Provide a Community Pharmacy NHS Influenza (‘Flu) Service? • Vaccinating people against ‘flu can prevent ill-health and possible death from ‘flu over the winter and reduce hospital admissions • This is true for the whole population, but especially important for the clinical at-risk groups • Primary care is not achieving high enough vaccination rates for clinical at-risk groups Supporting Community Pharmacy across Avon
How can a Pharmacy Service Make a Difference? • Increases the overall vaccination rates, especially in harder to reach groups through: • Better accessibility • Many convenient locations • Long opening hours – open when the patient needs us • Great patient satisfaction • We are already vaccinating people who are eligible for a free NHS flu Jab (via the private service) • ‘At-risk’ groups could attend a pharmacy up to five times within the ‘flu season for a prescription presenting opportunities for vaccination Supporting Community Pharmacy across Avon
Respiratory Disease Asthma that requires continuous or repeated • use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission Chronic obstructive pulmonary disease (COPD) • including chronic bronchitis and emphysema; bronchiectasis • cystic fibrosis, • interstitial lung fibrosis • pneumoconiosis • bronchopulmonary dysplasia (BPD) • Supporting Community Pharmacy across Avon
What to look out for: Anyone with a steroid inhaler • Anticholiergics (tiotropium, ipratropium…) • long acting B 2 agonist • Montelukast • Theophylline • Nebules • Steroids (for breathing.) • For cystic fibrois… Creon capsules • ursodeoxycholic acid, antibiotic nebulisers? Not just Ventolin!!! • Supporting Community Pharmacy across Avon
Chronic Heart Disease • Congenital heart disease • Hypertension with cardiac complications • Chronic heart failure • Individuals requiring regular medication and/or follow-up for ischaemic heart disease Supporting Community Pharmacy across Avon
What to look out for: • Congenital Heart disease - Patients with stents, replaced valves, ‘hole in the heart’ – not generally medically treated • Chronic heart failure • Symptoms include dyspnoea, especially during and after exertion (but even at rest if severe), wheeze, cold extremities to name but a few • Treated with combinations of loop diuretics, ACE- inhibitors, β-blocker, spironolactone, digoxin Supporting Community Pharmacy across Avon
What to look out for: • Ischaemic heart disease • AKA coronary heart disease, coronary artery disease • angina medication i.e. regular GTN, nitrates, β-blockers, calcium channel blockers etc. • Complications of hypertension – retinopathy, haemorrhage, kidney problems Supporting Community Pharmacy across Avon
Chronic Kidney Disease • Chronic kidney disease at stage 3, 4 or 5 • Chronic kidney failure • Nephrotic syndrome • Kidney transplantation Supporting Community Pharmacy across Avon
What to look out for: • Drugs including: • Vitamin D analogues including alfacalcidol • Phosphate binders (eg. Calcium, lanthanum, sevelamer, aluminium hydroxide) • High doses of loop diuretics • Immunosuppressants (e.g. ciclosporin, tacrolimus, azathioprine, mycophenolate) • ACE-inhibitors or angiotensin II receptor antagonists are used in nephrotic syndrome to address proteinuria as well as furosemide/spironolactone Supporting Community Pharmacy across Avon
Chronic Liver Disease • Cirrhosis • Biliary atresia • Chronic hepatitis Supporting Community Pharmacy across Avon
What to Look Out For: • Drugs including:- • Colestyramine • High dose ursodeoxycholic acid • Penacillamine • Spironolactone • Loop diuretics • Vitamins i.e. vitamin B, pyridoxine, fat soluble vitamins (A,D,E,K) • Disulfram, acamproste, chlordiazepoxide? • Substance misuse patients? Supporting Community Pharmacy across Avon
Chronic Neurological Disease • Stroke • Transient ischaemic attack (TIA) Supporting Community Pharmacy across Avon
What to Look out For: • Aspirin • Clopidogrel • Dipyridamole Supporting Community Pharmacy across Avon
Diabetes • Type 1 diabetes • Type 2 diabetes requiring insulin or oral hypoglycaemic drugs • Diet controlled diabetes Supporting Community Pharmacy across Avon
Immunosuppression • Anyone suffering from an immunosuppressive disorder e.g.:- • HIV • Patients undergoing chemotherapy • Bone marrow transplant • Myeloma • Disorders affecting the immune system eg IRAK-4, NEMO • Anyone taking the following medication:- • Azathioprine, mycophenolate, ciclosporin, cyclophosphamide, tacrolimus, methotrexate, high dose steroids (equivalent to 20mg prednisolone) for more than a month Supporting Community Pharmacy across Avon
Asplenia or Dysfunction of the Spleen • People with no spleen • Any dysfunction of the spleen • Coeliacs – Having coeliac disease can cause the spleen to work less effectively • Homozygous sickle cell disease – the spleen can become enlarged due to misshapen red blood cells Supporting Community Pharmacy across Avon
Pregnant Ladies • Any stage of pregnancy (1 st , 2 nd or 3 rd trimester) • Check for exemption status ‘D’ on the back of prescriptions • Pregnant ladies coming to the pharmacy for healthcare advice • Likely to be unsure of whether to have vaccine • Is it safe? • How is my baby affected? • What are the benefits? Supporting Community Pharmacy across Avon
Pregnant Ladies • A report found that of all the women who died from complications of pregnancy or childbirth, 1 in 11 of them died from flu • Having flu while pregnant could mean the baby is born prematurely or has a low birth weight, and may even lead to stillbirth or death in the 1 st week of life • Some of the immunity from the mother will pass across the placenta, and protect the baby into their 1 st few weeks of life – passive immunity Supporting Community Pharmacy across Avon
Informal (Unpaid) Carers • Must be the main carer of an elderly or disabled person • Must not be paid for this work, however may be in receipt of carer’s allowance • If they were to fall ill the welfare of the person they care for may be at risk • Could prevent ‘flu from passing to the vulnerable • Hard to know whether they are a carer or not Supporting Community Pharmacy across Avon
Exclusion Criteria • People who don’t fall into the above categories • Professional (i.e. paid) health and social care workers with no clinical risk conditions • Have had a flu vaccination since September 2015, or are unsure of vaccination • Suffering a febrile illness or acute infection • Known hypersensitivity to egg or egg products Supporting Community Pharmacy across Avon
Exclusion Criteria • Confirmed anaphylactic reaction to a previous dose of the vaccine or any component of it • Bleeding disorder or taking anticoagulant medication • Awaiting confirmation on these patients, and how we may be able to proceed • Refused consent Supporting Community Pharmacy across Avon
Delivering the service • Walk through of the service from the perspective of a pharmacist currently delivering flu vaccinations • Consent • Consultation room • Preparation • What it feels like to do your 1 st vaccination • Documentation • Q & A Supporting Community Pharmacy across Avon
Consent • For consent to be valid the patient must:- • Have the capacity to give consent • Be acting voluntarily – they must not be under any undue pressure from you or anyone else to make a decision • Have sufficient, balanced information to allow them to make an informed decision • Be capable of using and weighing up the information provided Supporting Community Pharmacy across Avon
Consultation Room • Furniture – Arrange the furniture in the room so that both you and the patient are comfortable, and so that you have enough space • Chair – Choose a chair for the patient which preferably has arm rests, but does not have wheels • Equipment – Position your equipment so that it is in easy reach while you conduct the vaccination • Sharps bin – Ensure that your sharps bin is positioned so that you will never have to reach across a patient with an unsheathed needle Supporting Community Pharmacy across Avon
Consultation Room • Patient's view – Think about what the patient will be looking at during the vaccination, and consider positioning them in view of a poster or other point of interest to distract them from the procedure • Tidy – Ensure that your consultation room is clean, tidy and professional looking • Exit – Make sure that the exit to the room is kept clear at all times Supporting Community Pharmacy across Avon
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